Uniform Residential Loan Application
This application is designed to be completed by the applicant(s) with the Lender’s assistance. Applicants should complete this form as “Borrower” or “Co-Borrower, as applicable. Co-
Borrower information must also be provided (and the appropriate box checked) when
the income or assets of a person other than the “Borrower” (including the Borrower’s spouse)
will be used as a basis for loan qualification or
the income or assets of the Borrower’s spouse or other person who has community property rights pursuant to state law will not be
used as a basis for loan qualification, but his or her liabilities must be considered because the spouse or other person has community property rights pursuant to applicable law and
Borrower resides in a community property state, the security property is located in a community property state, or the Borrower is relying on other property located in a community prop-
erty state as a basis for repayment of the loan.
If this is an application for joint credit, Borrower and Co-Borrower each agree that we intend to apply for joint credit (sign below):
Borrower Co-Borrower
I. TYPE OF MORTGAGE AND TERMS OF LOAN
Mortgage
VA
Conventional
Other (explain):
Agency Case Number Lender Case Number
Applied for:
FHA
USDA/Rural Housing Service
Amortization
Fixed Rate
Other (explain):
Type:
Amount Interest Rate No. of Months
GPM
ARM (type):
$ %
II. PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address (street, city, state & ZIP)
Legal Description of Subject Property (attach description if necessary)
Purpose of Loan
Purchase
Construction
Other (explain):
Property will be:
Primary Secondary
No. of Units
Year Built
Investment
Refinance
Construction-Permanent
Residence
Residence
Complete this line if construction or construction-permanent loan.
Year Lot
Acquired
Original Cost
$
Amount Existing Liens
$
(a) Present Value of Lot
$
(b) Cost of Improvements
$
Total (a + b)
$
Complete this line if this is a refinance loan.
III. BORROWER INFORMATION
Married
Separated
Title will be held in what Name(s)
Source of Down Payment, Settlement Charges, and/or Subordinate Financing (explain)
Borrower’s Name (include Jr. or Sr. if applicable)
Social Security Number
Present Address (street, city, state, ZIP)
Own
Rent______________No. Yrs.
Mailing Address, if different from Present Address Mailing Address, if different from Present Address
Present Address (street, city, state, ZIP)
Own
Rent______________No. Yrs.
Home Phone (incl. area code)
Dependents (not listed by Co-Borrower)
no. ages
DOB
(MM/DD/YYYY) Yrs. School
Co-Borrower’s Name (include Jr. or Sr. if applicable)
Manner in which Title will be held Estate will be held in:
Fee Simple
Leasehold
(show expiration date)
Year
Acquired
Original Cost
$
Amount Existing Liens
$
Purpose of Refinance
Describe Improvements
made
to be made
Cost: $
Borrower Co-Borrower
Unmarried (include single,
divorced, widowed)
Unmarried (include single,
divorced, widowed)
Social Security Number Home Phone (incl. area code) DOB (MM/DD/YYYY) Yrs. School
Married
Separated
Dependents (not listed by Borrower)
no. ages
If residing at present address for less than two years, complete the following:
IV. EMPLOYMENT INFORMATION
Former Address (street, city, state, ZIP)
Own
Rent______________No. Yrs. Former Address (street, city, state, ZIP)
Own
Rent______________No. Yrs.
Name & Address of Employer
Self Employed
Position/Title/Type of Business Business Phone (incl. area code)
Borrower Co-Borrower
Yrs. on this job
Yrs. employed in this line
of work/profession
Name & Address of Employer
Self Employed
Position/Title/Type of Business Business Phone (incl. area code)
Yrs. on this job
Yrs. employed in this line
of work/profession
If employed in current position for less than two years or if currently employed in more than one position, complete the following:
Name & Address of Employer
Self Employed
Dates (from - to)
Name & Address of Employer
Self Employed
Dates (from - to)
Monthly Income
$
Monthly Income
$
Position/Title/Type of Business Business Phone (incl. area code) Position/Title/Type of Business Business Phone (incl. area code)
Name & Address of Employer
Self Employed
Dates (from - to)
Name & Address of Employer
Self Employed
Dates (from - to)
Monthly Income
$
Monthly Income
$
Position/Title/Type of Business Business Phone (incl. area code) Position/Title/Type of Business Business Phone (incl. area code)
Freddie Mac Form 65 6/09 Page 1 of 4 Fannie Mae Form 1003 6/09
Stock No. 11518
130 HL - FNMA 1003/FHLMC 65 (3/12/13)W.B.A.
I I I I
I
I
I I I I I
I
I I I
I I
I I
I I
_____________________________________________________ _________________________________________________________
I I
V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
Gross Monthly Income Borrower Co-Borrower Total
Combined
Monthly Housing Expense
Present Proposed
Base Empl. Income* $ $ $
0.00
Rent
$
Overtime
0.00
First Mortgage (P&I)
$
Bonuses
0.00
Other Financing (P&I)
Commissions
0.00
Hazard Insurance
Dividends/Interest
0.00
Real Estate Taxes
Net Rental Income
0.00
Mortgage Insurance
Other
(before completing, see
the notice in “describe other
income.” below.)
0.00
Homeowner Assn. Dues
0.00
Other:
Total
$
0.00
$
0.00
$
0.00
Total $
0.00
$
0.00
* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
Describe Other Income
Notice:
Alimony, child support, or separate maintenance income need not be revealed if the
Borrower (B) or Co-Borrower (C) does not choose to have it considered for repaying this loan.
B/C Monthly Amount
$
VI. ASSETS AND LIABILITIES
This Statement and any applicable supporting schedules may be completed jointly by both married and unmarried Co-Borrowers if their assets and liabilities are sufficiently joined so that
the Statement can be meaningfully and fairly presented on a combined basis; otherwise, separate Statements and Schedules are required. If the Co-Borrower section was completed about
a non-applicant spouse or other person, this Statement and supporting schedules must be completed about that spouse or other person also.
Completed
Jointly
Not Jointly
ASSETS
Description
Cash or Market
Value
Liabilities and Pledged Assets. List the creditor’s name, address and account number for all outstanding debts,
including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges,
etc. Use continuation sheet, if necessary. Indicate by (*) those liabilities, which will be satisfied upon sale of real
estate owned or upon refinancing of the subject property.
Cash deposit toward purchase held by:
$
LIABILITIES
Monthly Payment &
Months left to Pay
Unpaid
Balance
Name and address of Company
$ Payment/Months $
List checking and savings accounts below
Name and address of Bank, S&L, or Credit Union
Acct. No.
Name and address of Company
$ Payment/Months $
Acct. No. $
Name and address of Bank, S&L, or Credit Union
Acct. No.
Name and address of Company
$ Payment/Months $
Acct. No. $
Name and address of Bank, S&L, or Credit Union
Acct. No.
Name and address of Company
$ Payment/Months $
Acct. No. $
Name and address of Bank, S&L, or Credit Union
Acct. No.
Name and address of Company
$ Payment/Months $
Acct. No. $
Stocks & Bonds (Company name/number
& description)
$
Acct. No.
Name and address of Company
$ Payment/Months $
Life Insurance net cash value
Face amount: $
$
Subtotal Liquid Assets $
0.00
Real estate owned (enter market value
from schedule of real estate owned)
$
Acct. No.
Vested interest in retirement fund $
Name and address of Company
$ Payment/Months $
Net worth of business(es) owned
(attach financial statement)
$
Automobiles owned (make and year) $
Acct. No.
Alimony/Child Support/Separate Maintenance Payments
Owed to:
$
Other Assets (itemize)
$
Job Related Expense (child care, union dues, etc.)
$
Total Monthly Payments
$
0.00
Total Assets a. $
0.00
Net Worth
(a minus b)
$
0.00
Total Liabilities b. $
0.00
Freddie Mac Form 65 6/09 Page 2 of 4 Fannie Mae Form 1003 6/09
VI. ASSETS AND LIABILITIES (cont.)
Insurance
Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.)
Property Address (enter S if sold, PS if pending sale
or R if rental being held for income)
Type of
Property
Present
Market Value
Amount of
Mortgages & Liens
Gross
Rental Income
Mortgage
Payments
Maintenance,
Taxes & Misc.
Net
Rental Income
$ $ $ $ $ $
Totals $
0.00
$
0.00
$
0.00
$
0.00
$
0.00
$
0.00
List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):
Alternate Name Creditor Name Account Number
VII. DETAILS OF TRANSACTION VIII. DECLARATIONS
a. Purchase price $
b. Alterations, improvements, repairs
c. Land (if acquired separately)
d. Refinance (incl. debts to be paid off)
e. Estimated prepaid items
f. Estimated closing costs
g. PMI, MIP, Funding Fee
h. Discount (if Borrower will pay)
i. Total costs (add items a through h)
0.00
j. Subordinate financing
k. Borrower’s closing costs paid by Seller
l. Other Credits (explain)
m. Loan amount
(exclude PMI, MIP, Funding Fee financed)
n. PMI, MIP, Funding Fee financed
o. Loan amount (add m &n)
0.00
p. Cash from/to Borrower
(subtract j, k, l & o from i)
0.00
If you answer “Yes” to any questions a through i, please use continuation
sheet for explanation.
a. Are there any outstanding judgments against you?
b. Have you been declared bankrupt within the past 7 years?
c. Have you had property foreclosed upon or given title or deed in lieu
thereof in the last 7 years?
d. Are you a party to a lawsuit?
e. Have you directly or indirectly been obligated on any loan which resulted
in foreclosure, transfer of title in lieu of foreclosure, or judgment?
(This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational
loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If
“Yes,” provide details, including date, name and address of Lender, FHA or VA case number, if any, and
reasons for the action.)
f. Are you presently deliquent or in default on any Federal debt or any
other loan, mortgage, financial obligation, bond, or loan guarantee?
If “Yes, give details as described in the preceding question.
g. Are you obligated to pay alimony, child support, or separate maintenance?
h. Is any part of the down payment borrowed?
i. Are you a co-maker or endorser on a note?
j. Are you a U.S. citizen?
k. Are you a permanent resident alien?
l. Do you intend to occupy the property as your primary residence?
If “Yes, complete question m below.
m. Have you had an ownership interest in a property in the last three years?
(1) What type of property did you own--principal residence (PR),
second home (SH), or investment property (IP)?
(2) How did you hold title to the home--solely by yourself (S), jointly
with your spouse (SP), or jointly with another person (O)?
Borrower Co-Borrower
Yes No Yes No
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













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IX. ACKNOWLEDGMENT AND AGREEMENT
Each of the undersigned specifically represents to Lender and to Lender’s actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns and agrees and
acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent misrepresentation of this
information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have
made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec. 1001, et seq.; (2) the loan
requested pursuant to this application (the “Loan”) will be secured by a mortgage or deed of trust on the property described in this application; (3) the property will not be used for any illegal or
prohibited purpose or use; (4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated in this
application; (6) the Lender, its servicers, successors or assigns may retain the original and/or an electronic record of this application, whether or not the Loan is approved; (7) the Lender and its
agents, brokers, insurers, servicers, successors and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information
provided in this application if any of the material facts that I have represented herein should change prior to closing of the Loan; (8) in the event that my payments on the Loan become delinquent,
the Lender, its servicers, successors or assigns may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account information to one
or more consumer reporting agencies; (9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be required by law; (10) neither Lender
nor its agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value of the
property; and (11) my transmission of this application as an “electronic record” containing my “electronic signature,” as those terms are defined in applicable federal and/or state laws (excluding
audio and video recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application
were delivered containing my original written signature.
Acknowledgement.
Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information contained in this
application or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting
agency.
Borrower’s Signature:
X
Date Co-Borrower’s Signature:
X
Date
X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES
The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender’s compliance with equal credit opportunity,
fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may not discriminate either
on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one
designation. If you do not furnish ethnicity, race or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have
made this application in person. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all
requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)
BORROWER
I do not wish to furnish this information
CO-BORROWER
I do not wish to furnish this information
Ethnicity:
Hispanic or Latino
Not Hispanic or Latino
Ethnicity:
Hispanic or Latino
Not Hispanic or Latino
Race:
American Indian or Alaska Native
Asian
White
Black or African American
Native Hawaiian or Other Pacific Islander
Race:
American Indian or Alaska Native
Asian
White
Black or African American
Native Hawaiian or Other Pacific Islander
Sex:
Female
Male
Sex:
Female
Male
To be Completed by Loan Originator:
Erin Otten NMLS #897590 Halie Meyer NMLS #1634032
Curt Meany NMLS #902080
This information was provided:
Joni Bock NMLS #470066 Devin Perry NMLS #469894
Nicole Brinkman NMLS #1514965
In a face-to-face interview
Mike Smith NMLS #466086 Brady Frericks NMLS #1431728
Marcia Hardin NMLS #1580496
In a telephone interview
Mary Smith NMLS #1043541 Angie Poppe NMLS #470114
Joshua Wilson NMLS #1681670
Thomas Nelson NMLS #1678652 Clinton Stewart NMLS #469688
Mary Dickey NMLS #1605734
By the applicant and submitted by fax or mail
Taylor Warbritton NMLS #1799344 Rebecca Schuefele NMLS #1791609
Larraleigh Hetzler NMLS #1751740
By the applicant and submitted via e-mail or the Internet
Loan Originator’s Signature
X
Date
Loan Originator’s Name (print or type) Loan Originator Identifier Loan Originator’s Phone Number (including area code)
(573)769-2001
Loan Origination Company’s Name
HOMEBANK
Loan Origination Company Identifier
450000
Loan Origination Company’s Address
400 South Main, PO Box 311, Palmyra, MO 63461
Freddie Mac Form 65 6/09 Page 3 of 4 Fannie Mae Form 1003 6/09
Continuation Sheet/Residential Loan Application
Use this continuation sheet if you Borrower: Agency Case Number:
need more space to complete the
Residential Loan Application.
Mark B for Borrower or C for
Co-Borrower.
Co-Borrower: Lender Case Number:
IMPORTANT INFORMATION ABOUT
PROCEDURES FOR OBTAINING CREDIT
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and
record information that identifies each person who obtains credit.
What this means for you: When you obtain credit, we will ask for your name, address, date of birth, and other information that will allow us to identify
you. We may also ask to see your drivers license or other identifying documents.
NOTICE: We may report information about your account to credit bureaus. Late payments, missed payments, or other defaults on your account may be
reflected in your credit report.
NOTICE TO MARRIED APPLICANTS: No provision of any marital property agreement, unilateral statement under §766.59, Wis. Stats., or court decree
under §766.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted or an open-end credit plan is entered
into, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision.
I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under
the provisions of Title 18, United States Code, Section 1001, et seq.
Borrower’s Signature: Date Co-Borrower’s Signature: Date
X X
Freddie Mac Form 65 6/09 Page 4 of 4 Fannie Mae Form 1003 6/09
Mortgage Application Checklist
The following documents may be required through the mortgage application process, but are not required to receive a
Loan Estimate.
Income
Past two years w-2’s & tax returns
Most recent paycheck stubs (30 day minimum)
Contact name & phone number to verbally verify employment
Verification of other income: social security, child support, retirement, etc.
If self-employed: past two years tax returns including all schedules and a profit and loss statement for
the current year signed by your accountant
Assets
Last two months statements for all bank and credit union accounts
Most recent retirement account statement if used for down payment or funds
Other Information Needed
Copy of driver's license for each borrower
Homeowner’s insurance agents name & phone number
Divorce decrees, if applicable, including property settlements, modifications, etc.
For Purchases Only
Contact name, phone number and address of all landlords for the past two years
Accepted purchase agreement and copy of listing sheet
Please note that any material changes in your employment, income, assets and/or credit must be reported
to us as soon as possible, as it may affect your financing. Also, you may provide computer print-outs of any
of the above documents, provided that they are dated and contain your full name, the institutions names, and
the full account number.
H8
ME
BANK
strength and service continues
___________________________________
___________________________________
____________________________________
_______________________________
_______________________________
______________________________
Credit Application and Borrower’s Certification
Type of Credit Requested-Check the appropriate boxes below and complete the applicable section.
secured individual credit relying solely on my income or assets
unsecured individual credit relying on my income or assets as well as
income or assets from other sources
joint credit we intend to apply for joint credit
entity owners – the undersigned understand they may be asked
to co-sign or guarantee the loan being requested as they are the
owners, officers or control parties for the entity.
Amount Requested Payment Due Desired Proceeds of Credit to be used for
$______________ __________________ ____________________________
Loan Number _______________ Date of Application ________________
Above references are for lender’s use only and do not limit the applicability of this document to any particular loan or item.
CERTIFICATION
The undersigned hereby certifies the accuracy of all financial statements provided in connection with
this credit application and indicates that our financial condition has not materially changed by
signing below.
-------------------------------------------- Fold to Copy --------------------------------------------
AUTHORIZATIONS
1) (I/We) authorize the bank to perform any credit investigation necessary to verify
information supplied to us by the following means:
By contacting banks or other credit sources disclosed to us to verify balance,
collateral and payment history.
By requesting and obtaining a credit report from a third party Credit Reporting
Agencies.
By contacting references provided.
2) (I/We) authorize the bank to report (my/our) names and information regarding this loan to
Credit Reporting Agencies.
3) (I/We) understand a copy of this authorization may be mailed or faxed to (my/our) creditors
as authorization to release information on (my/our) account directly to HOMEBANK and
any information received will be held strictly confidential and covered under the
HOMEBANK’s privacy policy.
4) In the event (my/our) loan is approved, (I/we) hereby authorize the HOMEBANK to request
payoff information directly from any creditor we intend to refinance with the proceeds.
Entity Name (if Applicable): _______________________________
Borrower
Borrower
Guarantor/Co-signer
Borrower
Borrower
Guarantor/Co-signer
Fees to be Collected: $_________ Interest $_________Other Fees = __________ Total to be Collected
Revised: 03/2015 als
BORROWER'S CERTIFICATION & AUTHORIZATION
Certification
The
undersigned
certify
the
following:
1.
I/We
have
applied
for
a
mortgage
loan
from
HOMEBANK
/lender). In
applying
for
the
loan,
I/we
completed
a loan
application
containing
various
information
on
the
purpose
of
the
loan,
the
amount
and
source
of
the
downpayment,
employment
and
income
information,
and assets and liabilities.
//We
certify
that
all
of
the
information
is
true
and
complete.
I/We
made no
misrepresentations
in
the
Joan
application
or
other
documents,
nor
did
I/we
omit
any
pertinent
information.
2.
I/We
understand
and agree
that
HOMEBANK
/lender) reserves
the
right
to
change
the
mortgage
Joan
review
process
to
a
full
documentation
program.
This
may
include
verifying
the
information
provided
on
the
application
with
the
employer
and/or
the
financial
institution.
3.
I/We
fully
understand
that
it
is a Federal
crime
punishable
by
fine
or
imprisonment,
or
both,
to
knowingly
make
any
false
statements
when
applying
for
this
mortgage,
as applicable
under
the
provisions
of
Title
18,
United
States
Code,
Section
1014.
Authorization
to
Release
Information
To
Whom
It
May
Concern:
1.
I/We
have
applied
for
a
mortgage
loan
from
HOMEBANK
/lender).
As
part
of
the
application
process,
HOMEBANK
/lender)
may
verify
information
contained
in
my/our
loan
application
and in
other
documents
required in
connection
with
the
loan,
either
before
the
loan is closed
or
as
part
of
its
quality
control
program.
2.
I/We
authorize
you
to
provide
to
HOMEBANK
/lender), and
to
any
investor
to
whom
HOMEBANK
/lender)
may
sell
my/our
mortgage,
any
and all
information
and
documentation
that
they
request.
Such
information
includes,
but
is
not
limited
to,
employment
history
and
income;
bank,
money
market,
and
similar
account
balances;
credit
history;
and copies
of
income
tax
returns.
3.
HOMEBANK
(lender)
or
any
investor
that
purchases
the
mortgage
may
address
this
authorization
to
any
party
named in
the
loan
application
or
disclosed
by
any
consumer
credit
reporting
agency
or
similar
source.
4. A
copy
of
this
authorization
may
be
accepted
as an original.
5.
Your
prompt
reply
to
HOMEBANK
/lender), or
the
investor
that
purchased
the
mortgage
is
appreciated.
________________________
Date.
_________
_
Individually
________________________
Date.
________
_
Individually
Missouri Borrower's Certification & Authorization
lnitials~-
Wolters Kluwer Financial Services VMP®
Page 1
NOTICE OF RIGHT TO RECEIVE COPY OF APPRAISAL/APPRAISAL EVALUATION
FROM:
HOMEBANK
400 SOUTH MAIN
P.O. BOX 311
PALMYRA, MO 63461
TO:
Loan Number: _________________
Property Address: ______________________________________________________________
Right to Receive Copy
We may order an appraisal to determine the property’s value and charge you for this appraisal. We will
promptly give you a copy of any appraisal/appraisal evaluation, even if your loan does not close.
You can pay for an additional appraisal for your own use at your own cost.
Acknowledgment
By signing below, you acknowledge you have received this Disclosure.
_____________________________________________________Date ____________________
_____________________________________________________Date ____________________
9
Form
4506-T
(July 2017)
Department of the Treasury
Internal Revenue Service
Request for Transcript of Tax Return
Do not sign this form unless all applicable lines have been completed.
Request may be rejected if the form is incomplete or illegible.
For more information about Form 4506-T, visit www.irs.gov/form4506t.
OMB No. 1545-1872
Tip. Use Form 4506-T to order a transcript or other return information free of charge. See the product list below. You can quickly request transcripts by using
our automated self-help service tools. Please visit us at IRS.gov and click on “Get a Tax Transcript...” under “Tools” or call 1-800-908-9946. If you need a copy
of your return, use Form 4506, Request for Copy of Tax Return. There is a fee to get a copy of your return.
1a Name shown on tax return. If a joint return, enter the name
shown first.
2a If a joint return, enter spouse’s name shown on tax return.
1b First social security number on tax return, individual taxpayer identification
number, or employer identification number (see instructions)
2b Second social security number or individual taxpayer
identification number if joint tax return
3 Current name, address (including apt., room, or suite no.), city, state, and ZIP code (see instructions)
4 Previous address shown on the last return filed if different from line 3 (see instructions)
5 If the transcript or tax information is to be mailed to a third party (such as a mortgage company), enter the third party’s name, address,
and telephone number.
Caution: If the tax transcript is being mailed to a third party, ensure that you have filled in lines 6 through 9 before signing. Sign and date the form once
you have filled in these lines. Completing these steps helps to protect your privacy. Once the IRS discloses your tax transcript to the third party listed
on line 5, the IRS has no control over what the third party does with the information. If you would like to limit the third party’s authority to disclose your
transcript information, you can specify this limitation in your written agreement with the third party.
6
Transcript requested. Enter the tax form number here (1040, 1065, 1120, etc.) and check the appropriate box below. Enter only one tax form
number per request.
a Return Transcript, which includes most of the line items of a tax return as filed with the IRS. A tax return transcript does not reflect
changes made to the account after the return is processed. Transcripts are only available for the following returns: Form 1040 series,
Form 1065, Form 1120, Form 1120-A, Form 1120-H, Form 1120-L, and Form 1120S. Return transcripts are available for the current year
and returns processed during the prior 3 processing years. Most requests will be processed within 10 business days . . . . . .
b
Account Transcript, which contains information on the financial status of the account, such as payments made on the account, penalty
assessments, and adjustments made by you or the IRS after the return was filed. Return information is limited to items such as tax liability
and estimated tax payments. Account transcripts are available for most returns. Most requests will be processed within 10 business days .
c Record of Account, which provides the most detailed information as it is a combination of the Return Transcript and the Account
Transcript. Available for current year and 3 prior tax years. Most requests will be processed within 10 business days . . . . . .
7 Verification of Nonfiling, which is proof from the IRS that you did not file a return for the year. Current year requests are only available
after June 15th. There are no availability restrictions on prior year requests. Most requests will be processed within 10 business days . .
8
Form W-2, Form 1099 series, Form 1098 series, or Form 5498 series transcript. The IRS can provide a transcript that includes data from
these information returns. State or local information is not included with the Form W-2 information. The IRS may be able to provide this
transcript information for up to 10 years. Information for the current year is generally not available until the year after it is filed with the IRS. For
example, W-2 information for 2011, filed in 2012, will likely not be available from the IRS until 2013. If you need W-2 information for retirement
purposes, you should contact the Social Security Administration at 1-800-772-1213. Most requests will be processed within 10 business days .
Caution: If you need a copy of Form W-2 or Form 1099, you should first contact the payer. To get a copy of the Form W-2 or Form 1099 filed
with your return, you must use Form 4506 and request a copy of your return, which includes all attachments.
Year or period requested. Enter the ending date of the year or period, using the mm/dd/yyyy format. If you are requesting more than four
years or periods, you must attach another Form 4506-T. For requests relating to quarterly tax returns, such as Form 941, you must enter
each quarter or tax period separately.
/ / / / / / / /
Caution: Do not sign this form unless all applicable lines have been completed.
Signature of taxpayer(s). I declare that I am either the taxpayer whose name is shown on line 1a or 2a, or a person authorized to obtain the tax
information requested. If the request applies to a joint return, at least one spouse must sign. If signed by a corporate officer, 1 percent or more
shareholder, partner, managing member, guardian, tax matters partner, executor, receiver, administrator, trustee, or party other than the taxpayer, I
certify that I have the authority to execute Form 4506-T on behalf of the taxpayer. Note: This form must be received by IRS within 120 days of the
signature date.
Signatory attests that he/she has read the attestation clause and upon so reading declares that he/she
has the authority to sign the Form 4506-T. See instructions.
Phone number of taxpayer on line
1a or 2a
Signature (see instructions) Date
Sign
Title (if line 1a above is a corporation, partnership, estate, or trust)
Spouse’s signature Date
For Privacy Act and Paperwork Reduction Act Notice, see page 2.
Cat. No. 37667N
Form
4506-T (Rev. 7-2017)
Here
HOMEBANK c/o DataVerify, 875 Greentree Road, 8 Parkway Center, Pittsburgh, PA 15220 (866) 895-3282
click to sign
signature
click to edit
Form 4506-T (Rev. 7-2017)
Page
2
Section references are to the Internal Revenue Code
unless otherwise noted.
Future Developments
For the latest information about Form 4506-T and its
instructions, go to www.irs.gov/form4506t.
Information about any recent developments affecting
Form 4506-T (such as legislation enacted after we
released it) will be posted on that page.
General Instructions
Caution: Do not sign this form unless all applicable
lines have been completed.
Purpose of form. Use Form 4506-T to request tax
return information. You can also designate (on line 5)
a third party to receive the information. Taxpayers
using a tax year beginning in one calendar year and
ending in the following year (fiscal tax year) must file
Form 4506-T to request a return transcript.
Note: If you are unsure of which type of transcript
you need, request the Record of Account, as it
provides the most detailed information.
Tip. Use Form 4506, Request for Copy of
Tax Return, to request copies of tax returns.
Automated transcript request. You can quickly
request transcripts by using our automated
self-help service tools. Please visit us at IRS.gov and
click on “Get a Tax Transcript...” under “Tools” or
call 1-800-908-9946.
Where to file. Mail or fax Form 4506-T to
the address below for the state you lived in,
or the state your business was in, when that return
was filed. There are two address charts: one for
individual transcripts (Form 1040 series and Form
W-2) and one for all other transcripts.
If you are requesting more than one transcript or
other product and the chart below shows two
different addresses, send your request to the
address based on the address of your most recent
return.
Chart for individual transcripts
(Form 1040 series and Form W-2
and Form 1099)
If you filed an
individual return Mail or fax to:
and lived in:
Alabama, Kentucky,
Louisiana, Mississippi,
Tennessee, Texas, a Internal Revenue Service
foreign country, American RAIVS Team
Samoa, Puerto Rico, Stop 6716 AUSC
Guam, the Austin, TX 73301
Commonwealth of the
Northern Mariana Islands,
the U.S. Virgin Islands, or 855-587-9604
A.P.O. or F.P.O. address
Alaska, Arizona, Arkansas,
California, Colorado,
Hawaii, Idaho, Illinois, Internal Revenue Service
Indiana, Iowa, Kansas, RAIVS Team
Michigan, Minnesota, Stop 37106
Montana, Nebraska, Fresno, CA 93888
Nevada, New Mexico,
North Dakota, Oklahoma,
Oregon, South Dakota,
Utah, Washington, 855-800-8105
Wisconsin, Wyoming
Connecticut, Delaware,
District of Columbia,
Florida, Georgia, Maine, Internal Revenue Service
Maryland, Massachusetts, RAIVS Team
Missouri, New Hampshire, Stop 6705 P-6
New Jersey, New York, Kansas City, MO 64999
North Carolina, Ohio,
Pennsylvania, Rhode
Island, South Carolina,
Vermont, Virginia, West 855-821-0094
Virginia
Chart for all other transcripts
If you lived in
or your business Mail or fax to:
was in:
Alabama, Alaska,
Arizona, Arkansas,
California, Colorado,
Florida, Hawaii, Idaho,
Iowa, Kansas,
Louisiana, Minnesota,
Mississippi,
Internal Revenue Service
Missouri, Montana,
RAIVS Team
Nebraska, Nevada,
P.O. Box 9941
New Mexico,
Mail Stop 6734
North Dakota,
Ogden, UT 84409
Oklahoma, Oregon,
South Dakota, Texas,
Utah, Washington,
Wyoming, a foreign
country, American
855-298-1145
Samoa, Puerto Rico,
Guam, the
Commonwealth of the
Northern Mariana
Islands, the U.S. Virgin
Islands, or A.P.O. or
F.P.O. address
Connecticut,
Delaware, District of
Columbia, Georgia,
Internal Revenue Service
Illinois, Indiana,
RAIVS Team
Kentucky, Maine,
P.O. Box 145500
Maryland,
Stop 2800 F
Massachusetts,
Cincinnati, OH 45250
Michigan, New
Hampshire, New
Jersey, New York,
North Carolina,
Ohio, Pennsylvania,
Rhode Island, South
855-800-8015
Carolina, Tennessee,
Vermont, Virginia,
West Virginia,
Wisconsin
Line 1b. Enter your employer identification number
(EIN) if your request relates to a business return.
Otherwise, enter the first social security number
(SSN) or your individual taxpayer identification
number (ITIN) shown on the return. For example, if
you are requesting Form 1040 that includes
Schedule C (Form 1040), enter your SSN.
Line 3. Enter your current address. If you use a P.O.
box, include it on this line.
Line 4. Enter the address shown on the last return
filed if different from the address entered on line 3.
Note: If the addresses on lines 3 and 4 are different
and you have not changed your address with the
IRS, file Form 8822, Change of Address. For a
business address, file Form 8822-B, Change of
Address or Responsible Party — Business.
Line 6. Enter only one tax form number per
request.
Signature and date. Form 4506-T must be signed
and dated by the taxpayer listed on line 1a or 2a.
The IRS must receive Form 4506-T within 120 days
of the date signed by the taxpayer or it will be
rejected. Ensure that all applicable lines are
completed before signing.
!
CAUTION
You must check the box in the signature
area to acknowledge you have the
authority to sign and request the
information. The form will not be
processed and returned to you if the
box is unchecked.
Individuals. Transcripts of jointly filed tax returns
may be furnished to either spouse. Only one
signature is required. Sign Form 4506-T exactly as
your name appeared on the original return. If you
changed your name, also sign your current name.
Corporations. Generally, Form 4506-T can be
signed by: (1) an officer having legal authority to bind
the corporation, (2) any person designated by the
board of directors or other governing body, or (3)
any officer or employee on written request by any
principal officer and attested to by the secretary or
other officer. A bona fide shareholder of record
owning 1 percent or more of the outstanding stock
of the corporation may submit a Form 4506-T but
must provide documentation to support the
requester's right to receive the information.
Partnerships. Generally, Form 4506-T can be
signed by any person who was a member of the
partnership during any part of the tax period
requested on line 9.
All others. See section 6103(e) if the taxpayer has
died, is insolvent, is a dissolved corporation, or if a
trustee, guardian, executor, receiver, or
administrator is acting for the taxpayer.
Note: If you are Heir at law, Next of kin, or
Beneficiary you must be able to establish a material
interest in the estate or trust.
Documentation. For entities other than individuals,
you must attach the authorization document. For
example, this could be the letter from the principal
officer authorizing an employee of the corporation or
the letters testamentary authorizing an individual to
act for an estate.
Signature by a representative. A representative
can sign Form 4506-T for a taxpayer only if the
taxpayer has specifically delegated this authority to
the representative on Form 2848, line 5. The
representative must attach Form 2848 showing the
delegation to Form 4506-T.
Privacy Act and Paperwork Reduction Act Notice.
We ask for the information on this form to establish
your right to gain access to the requested tax
information under the Internal Revenue Code. We
need this information to properly identify the tax
information and respond to your request. You are
not required to request any transcript; if you do
request a transcript, sections 6103 and 6109 and
their regulations require you to provide this
information, including your SSN or EIN. If you do not
provide this information, we may not be able to
process your request. Providing false or fraudulent
information may subject you to penalties.
Routine uses of this information include giving it to
the Department of Justice for civil and criminal
litigation, and cities, states, the District of Columbia,
and U.S. commonwealths and possessions for use
in administering their tax laws. We may also disclose
this information to other countries under a tax treaty,
to federal and state agencies to enforce federal
nontax criminal laws, or to federal law enforcement
and intelligence agencies to combat terrorism.
You are not required to provide the information
requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB
control number. Books or records relating to a form
or its instructions must be retained as long as their
contents may become material in the administration
of any Internal Revenue law. Generally, tax returns
and return information are confidential, as required
by section 6103.
The time needed to complete and file Form
4506-T will vary depending on individual
circumstances. The estimated average time is:
Learning about the law or the form, 10 min.;
Preparing the form, 12 min.; and Copying,
assembling, and sending the form to the IRS,
20 min.
If you have comments concerning the accuracy of
these time estimates or suggestions for making
Form 4506-T simpler, we would be happy to hear
from you. You can write to:
Internal Revenue Service
Tax Forms and Publications Division
1111 Constitution Ave. NW, IR-6526
Washington, DC 20224
Do not send the form to this address. Instead, see
Where to file on this page.
HOMEBANK
400
SOUTH
MAIN, P O
BOX
311
PALMYRA.
MO
63461
MORTGAGE FRAUD
IS
INVESTIGATED BY THE FBI
Mortgage Fraud
is
investigated by the Federal Bureau
of
Investigation and
is
punishable by up to 30 years in federal prison or $1,000,000 fine, or both. It is
illegal for a person to make any false statement regarding income, assets, debt, or
matters
of
identification,
or
to willfully overvalue any land or property, in a loan
and credit application for the purpose
of
influencing in any way the action
of
a
financial institution.
Some
of
the applicable Federal criminal statutes which
may
be
charged
in
connection
with
Mortgage
Fraud include:
18
U.S.C.
§
1001
- Statements or entries generally
18
U.S.C.
§
1010 - HUD and Federal Housing Administration Transactions
18
u.s.c.
§
1014 - Loan
and
credit applications generally
18
u.s.c.
§
1028
- Fraud
and
related activity in connection with identification documents
18
U.S.C.
§
1341
- Frauds and swindles
by
Mail
18
U.S.C.
§
1342 - Fictitious name or address
18
U.S.C.
§
1343
- Fraud by wire
18
u.s.c.
§
1344 - Bank Fraud
42 U.S.C.
§
408(a) - False Social Security Number
Unauthorized use
of
the FBI seal, name, and initials is subject
to
prosecution under Sections
701,
709,
and
712
of
Title 18
of
the
United States Code.
771is
advisement may not be changed or altered wilhout the specific written consent
of
the Federal Bureau
of
Investigation,
and
is
not
an
endorsement
of
any
product
or
service.
Signature
Date
Signature
Date
Wolters Kluwer Financial
Services
©
2011
VMP554A
(1103)
0 0
0 0
0 0
Demographic Information Addendum. This section asks about your ethnicity, sex, and race.
Demographic Information of Borrower
The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of communities
and neighborhoods are being fulfilled. For residential mortgage lending, federal law requires that we ask applicants for their demographic
information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage
disclosure laws. You are not required to provide this information, but are encouraged to do so. The law provides that we may not discriminate
on the basis of this information, or on whether you choose to provide it. However, if you choose not to provide the information and you have
made this application in person, federal regulations require us to note your ethnicity, sex, and race on the basis of visual observation or surname.
The law also provides that we may not discriminate on the basis of age or marital status information you provide in this application.
Instructions: You may select one or more “Hispanic or Latino” origins and one or more designations for “Race.If you do not wish to provide
some or all of this information, select the applicable check box.
Ethnicity
Hispanic or Latino
Mexican Puerto Rican Cuban
Other Hispanic or Latino – Enter origin:
Examples: Argentinean, Colombian, Dominican, Nicaraguan,
Salvadoran, Spaniard, etc.
Not Hispanic or Latino
I do not wish to provide this information
Sex
Female
Male
I do not wish to provide this information
Race
American Indian or Alaska Native
Enter name of enrolled
or
principal tribe:
Asian
Asian Indian Chinese Filipino
Japanese Korean Vietnamese
Other Asian
Enter race:
Examples: Hmong, Laotian, Thai, Pakistani, Cambodian, etc.
Black or African American
Native Hawaiian or Other Pacic Islander
Native Hawaiian Guamanian or Chamorro Samoan
Other Pacic Islander
Enter race:
Examples: Fijian, Tongan, etc.
White
I do not wish to provide this information
To
Be Completed by Financial Institution (for application taken in person):
Was the ethnicity of the Borrower collected on the basis of visual observation or surname?
Was the sex of the Borrower collected on the basis of visual observation or surname?
Was the race of the Borrower collected on the basis of visual observation or surname?
NO
NO
NO
YES
YES
YES
The Demographic Information was provided through:
Face-to-Face Interview (includes Electronic Media w/ Video Component) Telephone Interview Fax or Mail Email or Internet
Borrower Name:
Uniform Residential Loan Application
Freddie Mac Form 65 • Fannie Mae Form 1003
Revised 08/2016 • Effective 01/2018
0 0
0 0
0 0
Demographic Information Addendum. This section asks about your ethnicity, sex, and race.
Demographic Information of Borrower
The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of communities
and neighborhoods are being fulfilled. For residential mortgage lending, federal law requires that we ask applicants for their demographic
information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage
disclosure laws. You are not required to provide this information, but are encouraged to do so. The law provides that we may not discriminate
on the basis of this information, or on whether you choose to provide it. However, if you choose not to provide the information and you have
made this application in person, federal regulations require us to note your ethnicity, sex, and race on the basis of visual observation or surname.
The law also provides that we may not discriminate on the basis of age or marital status information you provide in this application.
Instructions: You may select one or more “Hispanic or Latino” origins and one or more designations for “Race.If you do not wish to provide
some or all of this information, select the applicable check box.
Ethnicity
Hispanic or Latino
Mexican Puerto Rican Cuban
Other Hispanic or Latino – Enter origin:
Examples: Argentinean, Colombian, Dominican, Nicaraguan,
Salvadoran, Spaniard, etc.
Not Hispanic or Latino
I do not wish to provide this information
Sex
Female
Male
I do not wish to provide this information
Race
American Indian or Alaska Native
Enter name of enrolled
or
principal tribe:
Asian
Asian Indian Chinese Filipino
Japanese Korean Vietnamese
Other Asian
Enter race:
Examples: Hmong, Laotian, Thai, Pakistani, Cambodian, etc.
Black or African American
Native Hawaiian or Other Pacic Islander
Native Hawaiian Guamanian or Chamorro Samoan
Other Pacic Islander
Enter race:
Examples: Fijian, Tongan, etc.
White
I do not wish to provide this information
To
Be Completed by Financial Institution (for application taken in person):
Was the ethnicity of the Borrower collected on the basis of visual observation or surname?
Was the sex of the Borrower collected on the basis of visual observation or surname?
Was the race of the Borrower collected on the basis of visual observation or surname?
NO
NO
NO
YES
YES
YES
The Demographic Information was provided through:
Face-to-Face Interview (includes Electronic Media w/ Video Component) Telephone Interview Fax or Mail Email or Internet
Borrower Name:
Uniform Residential Loan Application
Freddie Mac Form 65 • Fannie Mae Form 1003
Revised 08/2016 • Effective 01/2018
____________________________________ _____________________________________
CRITICAL CLIENT INFORMATION REGARDING DEBT AND CREDIT
Thank you for allowing us to assist you with your home financing needs. Our top priority is to provide
our clients with outstanding, personalized service and a stress-free mortgage process. To help ensure
there are no surprises and your loan closes as expected, it is of critical importance that you are aware of
the following:
All existing and new debts must be considered for qualification purposes prior to funding your loan. This
means that your file could be subject to a pre-funding check to verify that:
You have not acquired any new debt or opened any new accounts/loans;
Your current loan balances have not increased (applies to loans, credit cards, lines of credit, etc.)
You do not have any new delinquencies on any existing account or any new public records
(judgments, bankruptcies, etc.)
Your credit score has not decreased.
These requirements apply to the borrower and any co-borrowers on the loan. If any of the above
changes are discovered through verification or obtaining of a new credit report, the file is subject to re-
qualification and/or re-underwriting.
If we must re-qualify and/or re-underwrite your loan, you must qualify with your updated debt and
credit profile. If you no longer qualify, we may not be able to fund your loan and any charges incurred
would be your responsibility.
If you suspect your credit or debt profile may have changed at any point between your approval and
loan funding, please notify your Loan Officer as soon as possible. This will help us stay “ahead of the
curve” and do everything we can to ensure your loan funds without any challenges.
Thank you for your cooperation! We look forward to serving you.
By signing below, I acknowledge I read and understood the information provided above.
Borrower Date Borrower Date
Affiliated Business Arrangement Disclosure Statement
Lender Borrower
HOMEBANK
400 S Main
P O Box 311
Palmyra, MO 63461
Date:
Loan Number:
Property:
This is to give you notice that HOMEBANK has a business relationship with Maine Street Title Services. The nature of
the relationship (and percentage of ownership interest) is:
Maine Street Title Services Subsidiary of Holding Corp, 100%
Because of this relationship, this referral may provide HOMEBANK a financial or other benefit.
x Set forth below is the estimated charge or range of charges for the settlement services listed. You are NOT required
to use the listed provider(s) as a condition for
l settlement of your loan on [or] x purchase, sale, or refinance of the
subject property.
THERE ARE FREQUENTLY OTHER SETTLEMENT
SERVICE PROVIDERS AVAILABLE WITH SIMILAR SERVICES.
YOU ARE FREE TO SHOP AROUND TO DETERMINE THAT
YOU ARE RECEIVING THE BEST SERVICES AND THE BEST
RATE FOR THESE SERVICES.
Provider and settlement service
Charge or range of charges
Maine Street Title Services, Incoming/Outgoing
Wire Charges, if applicable
$25.00
Maine Street Title Services, Express Delivery
Fee per Package, if applicable
$20.00
Maine Street Title Services, Title Search Fee $75.00
Maine Street Title Services, Closing Fee $150.00
Maine Street Title Services, Closing Protection
Letter
$25.00
Maine Street Title Services, Curative Services
Fee, if applicable
$50.00
Maine Street Title Services, Title Insurance
Premium
$1.40 per Thousand to $0.24 per Thousand
l Set forth below is the estimated charge or range of charges for the settlement services of an attorney, credit reporting
agency or real estate appraiser that we, as your lender, will require you to use, as a condition of your loan on this property,
to represent our interests in the transaction.
Affiliated Business Arrangement Disclosure
Bankers Systems™ VMP® 12/2017
Wolters Kluwer Financial Services © 2014 18.1.0.1520-J20180209N Page 1 of 2
ACKNOWLEDGMENT
I/We have read this disclosure form, and understand that HOMEBANK is referring me/us to purchase the above-described
settlement service(s) and may receive a financial or other benefit as a result of this referral.
Borrower
Date Date
Affiliated Business Arrangement Disclosure
Bankers Systems™ VMP® 12/2017
Wolters Kluwer Financial Services © 2014 18.1.0.1520-J20180209N Page 2 of 2
FACTS
Rev 11/02/2015
WHAT DOES HOMEBANK DO
WITH YOUR PERSONAL INFORMATION?
Why?
consumers the right to limit some but not all sharing. Federal law also requires us to tell you
how we collect, share, and protect your personal information. Please read this notice carefully
What?
The types of personal information we collect and share depend on the product or service you
have with us. This information can include:
Social Security number and income
Account balances and payment history
Credit history and credit scores
When you are no longer our customer, we continue to share your information as described in
this notice.
How?
All financial companies need to share customers’ personal information to run their everyday
business. In the section below, we list the reasons financial companies can share their
customers’ personal information; the reasons HOMEBANK chooses to share; and whether
you can limit this sharing.
Reasons we can share your personal information Does HOMEBANK share?
Can you limit this
sharing?
For our everyday business purposes
such as to process your transactions, maintain
your account(s), respond to court orders and legal
investigations, or report to credit bureaus
Yes No
For our marketing purposes
to offer our products and services to you
No No
For joint marketing with other financial companies
No No
For our affiliates’ everyday business purposes
information about your transactions and experiences
No No
For our affiliates’ everyday business purposes
information about your creditworthiness
No No
For our affiliates to market to you
No No
For non-affiliates to market to you
No No
Questions?
Call us at 573-769-2001 or Toll-Free at 1-855-577-2001 or
go to www.myhomebank.bank
click to sign
signature
click to edit
Page 2
Who we are
Who is providing this notice? HOMEBANK
What we do
How does HOMEBANK protect my To protect your personal information from unauthorized access
personal information? and use, we use security measures that comply with federal law.
These measures include computer safeguards and secured files
and buildings.
How does HOMEBANK collect my
We collect your personal information, for example, when you
personal information?
Open an account or deposit money
Pay your bills or apply for a loan
Use your credit or debit card
We also collect your personal information from others, such as credit
bureaus.
Why can’t I limit all sharing?
Federal law gives you the right to limit only
sharing for affiliates’ everyday business purposesinformation
about your creditworthiness
affiliates from using your information to market to you
sharing for non-affiliates to market to you
State laws and individual companies may give you additional rights to
limit sharing.
Definitions
Affiliates Companies related by common ownership or control. They can be
financial and nonfinancial companies.
Our affiliates include companies with a common corporate identity of
HOMEBANK; financial companies such as Home Bank of C
alifornia,
Byron B. Webb, Inc., LaJolla Fund LLC, and others, such as The
Webb Co. LLC and Maine Street Services, LLC
Non-affiliates Companies not related by common ownership or control. They can be
financial and nonfinancial companies.
HOMEBANK does not share with non-affiliates so they can market
to you.
Joint marketing A formal agreement between nonaffiliated financial companies that
together market financial products or services to you.
HOMEBANK does not jointly market.
Other important information
HOMEBANK works diligently to safeguard the information you give to us. We do NOT share any information about you,
except as permitted by law. We restrict access to information about you to those employees who need to know that
information to provide products or services to you. We maintain physical electronic and procedural safeguards to
protect this information.
H.
ME
BANK
strength and service continues
400 S. Main
P.O. Box 311
Palmyra, Missouri 63461
573-769-2001
Fax 573-769-2345
IMPORTANT INFORMATION ABOUT THE PROCEDURES FOR OPENING A
NEW ACCOUNT
To help the government fight the funding of Terrorism and money laundering
activities, Federal law requires all financial institutions to obtain, verify, and record
information that identifies each person who opens an account.
What that means for you: When you open an account, we will ask for your name,
address, date of birth, and other information that will allow us to identify you. We will
also ask to copy your driver's license
Identification is for verification of identity only and will in no way be used in the loan
credit process
***Payment made by you in person, by mail or electronically Monday through Friday,
prior to 5:00pm will be credited on the day we receive them
***Payments received on Friday after 5:00pm or Saturday will be credited on the next
business day.